A new government study highlights just how violent America’s recent past has been by showing a surge in gunfire injuries during the COVID-19 pandemic, when the number of people fatally shooting each other — and themselves — also increased.

The number of people injured by gunfire was nearly 40% higher in 2020 and 2021, compared with 2019, the Centers for Disease Control and Prevention said in a study published Thursday. In 2022, gun injuries tapered off, but were still 20% higher than before the pandemic.

Gun injuries rose similarly for men and women over the past three years, while the largest proportional increase occurred among children younger than 15, a subset that remains a small fraction of the overall problem.

Experts say the CDC gun injury study, which uses data from hospital emergency departments, helps provide a more comprehensive picture of gun violence in America than simply measuring homicides and suicides.

“Hospitals are a great place to keep the pulse on who is being shot, and when and where,” said Catherine Barber, a senior injury researcher at Harvard University’s school of public health.

The CDC study results came from more than 2,200 U.S. hospital emergency departments, which represent the bulk of the nation’s ERs, said Thomas Simon, one of the authors of the new study.

The study suggests that the number of gunshot-related ER visits at hospitals in the study rose from around 50,000 in 2019 to more than 72,000 in 2020. Because more than a quarter of U.S. hospital emergency departments were not involved in the study, the actual number is likely significantly higher.

Experts believe a variety of factors contributed to the pandemic surge in gun violence, including a rise in guns purchased, more time spent inside homes where guns are present and mental health struggles stemming from social isolation and economic hardships.

The CDC study shows a rise in gun injuries around mid-March 2020, after a pandemic emergency was declared and lockdowns and other measures were put into place. A sharper jump occurred a couple of months later, in the second half of May, when protests and civil unrest followed the Minneapolis police killing of George Floyd.

While the CDC study did not differentiate between injuries caused by assaults or accidents, other research has shown that about 3 out of 4 gunshot wounds are intentional.

The CDC says more than 45,000 people died from gun-related injuries in the U.S. in 2020, and more than 47,000 in 2021.

The country’s gun violence problem was thrust into the national conversation again this week after a shooter killed 3 children and 3 adults at a Christian school in Tennessee; nobody who was shot survived. The shooter was killed by police.

“We are in a week when people are paying attention to this issue again, sadly, after a mass shooting in Nashville” said Nina Vinik, executive director of Project Unloaded, an advocacy group focused on the impact of gun violence on children. “Hopefully this paper will add new data to that conversation.”